Obsessive Compulsive Disorder (ODD) is now recognized as a common mental disorder, occurring in perhaps four million people in this country alone. In adolescents, the prevalence may be one percent. Positron Emission Tomography with 18 adults with childhood onset OCD shows most significant increase in anterior cingulate and right prefrontal areas. This increase correlates with anxiety state during scan, severity of OCD, and clinical response to clomipramine. Fifty-one children and adolescents are enrolled in an ongoing double-blind comparison of clomipramine (CMI) and desmethylimipramine (DMI). DMI is virtually without benefit, while 70% of OC subjects receive at least some help from CMI. Trichotillomania (hair pulling) also appears to respond to CMI. Two single-blind and seven double-blind comparisons with DMI have been completed and results are more dramatic than for OCD. Adolescents with Sydenham's chorea have significantly higher incidence of OCD than controls with rheumatic fever alone. This implicates the basal ganglia in pathophysiology of OCD.